Enhancing the public health benefits of mammography screening by informing women of both breast cancer and breast arterial calcification results: A randomized trial to promote cardiovascular health

乳房X光检查是癌症预防中最成功的癌症筛查工具之一。今年，美国将有3700万女性接受乳房X光检查，之后，这些女性将收到一封信，让她们知道自己是否有乳腺癌的证据。最近的研究表明，标准的数字乳房X线摄影还产生了对妇女健康至关重要的额外信息;即关于乳房动脉内钙化存在的信息-乳房动脉钙化（BAC）。BAC的存在与冠状动脉内的钙化有关，这是冠状动脉疾病（CAD）的标志物。研究表明，至少有12.7%的女性乳房X光片显示BAC -约八分之一。在BAC患者中，32%-96%患有CAD。因此，保守地说，乳房X线摄影每年可以检测到超过150万例CAD病例。尽管有这种潜在的公共卫生布恩，BAC信息并没有直接传达给患者的乳房X线摄影后的信件。未能传达BAC状态是一个错失的机会，告知妇女CAD风险，并与患者的喜好不一致。这项提案的目的是调查是否BAC信息提供给妇女后乳房X光检查影响他们的心血管健康行为。我们将随机选择乳房X光检查显示BAC的患者，（N= 1，889，英语和西班牙语）：a）BAC增强字母条件，告知妇女其阳性BAC结果和BAC-CAD协会，鼓励妇女寻求预防性心脏病护理，并提供心脏病转诊信息;或B）等待名单对照条件，其中患者最初接收标准乳房X线照相术信函，并在6个月后了解他们的BAC状态。我们假设，收到BAC增强信的女性更有可能参加心血管健康预约（主要结局），参与心脏健康行为，并检测到CAD。在常识模型的指导下，我们试图了解哪些心理因素介导了干预和结果之间的关系。此外，大多数BAC患病率文献主要是在白色样本中进行的。为了纠正这一点，我们将在一个大的，种族和民族多样化的样本（N= 14，875）中描述BAC的患病率。创新：这将是第一项以“直接面向消费者”的方式与接受乳房X光检查的妇女直接分享BAC信息的干预研究，也是第一项报告不同种族和民族样本中BAC患病率的研究。公共卫生影响：该项目是确保妇女直接受益于乳房X光检查所能产生的所有丰富健康数据的第一步。

Breast mammography is one of the most successful cancer screening tools in the cancer prevention arsenal. 37 million women in the US will receive a mammogram this year, and following that, these women will receive a letter letting them know whether they do or do not have evidence of breast cancer. Recent research indicates that standard digital mammography also yields additional information critical to women’s health; that is, information about the presence of calcifications within breast arteries - breast arterial calcification (BAC). The presence of BAC has been associated with calcification within coronary arteries, which is a marker of coronary artery disease (CAD). Research indicates that at least 12.7% of women’s mammograms reveal BAC – about 1 in 8. Of those with BAC, 32%-96% have CAD. Thus, conservatively, mammography could detect over 1.5 million cases of CAD each year. Despite this potential public health boon, BAC information is not directly communicated to patients in the post-mammography letter. The failure to communicate BAC status is a missed opportunity to inform women about CAD risk, and is inconsistent with patient preferences. The goal of this proposal is to investigate whether provision of BAC information to women post-mammography influences their cardiovascular health behaviors. We will randomize mammography patients whose imaging reveals BAC (N=1,889, English and Spanish-speaking) to either: a) the BAC-Enhanced letter condition which informs women about their positive BAC findings and the BAC-CAD association, encourages women to seek preventive cardiology care, and provides cardiology referral information; or b) the Waitlist Control condition, where patients receive a standard mammography letter initially and learn their BAC status 6 months later. We hypothesize that women who receive the BAC-Enhanced letter will be more likely to attend a cardiovascular health appointment (primary outcome), engage in heart healthy behavior, and have CAD detected. Guided by the Common Sense Model, we seek to understand which psychological factors mediate the relationship between the intervention and the outcomes. Also, most BAC prevalence literature has been conducted on predominantly white samples. To remedy this, we will describe BAC prevalence in a large, racially and ethnically diverse sample (N=14,875). Innovation: This will be the first study of an intervention to directly share BAC information with women undergoing mammography in a “direct to consumer” approach, and the first to report BAC prevalence in a racially and ethnically diverse sample. Public health impact: The project is a first step towards ensuring that women benefit directly from all of the rich health data that mammography can yield.